Refund Request · Customer Self-Service

Full Name

*

Transaction Date and Time

*

Preferred Contact Method

Phone Number

*

Mode

Email Address

**

Transit Center

Street Address

*

TVM#

*

Street Address 2

*

Point of Sale

*

City

*

Fare Media

State

Requested Amount

*

Zip Code

*

Paid By

Reason for Request

*

NCTD Case Type

Customer

Origin

Status Reason

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